Correlation of Pap smear and visual inspection with acetic acid for screening of premalignant and malignant lesion of cervix


  • Anshu Singh Department of Pathology, IMS BHU, Varanasi, Uttar Pradesh
  • Kalpana Singh Department of Obstetrics and Gynaecology, IMS BHU, Varanasi, Uttar Pradesh
  • Nisha Rani Agarwal Department of Obstetrics and Gynaecology, IMS BHU, Varanasi, Uttar Pradesh



Ca cervix, Pap smear, VIA, Screening


Background: Cervical cancer still remains a leading cause of morbidity and mortality among women worldwide. Despite attempts to increase screening over the past several decades, incidence and mortality rates of cancer cervix have not shown substantial reduction. The conventional method of screening by cervical cytology/pap smear has failed to reduce the disease burden due to lack of patient compliance for repeated testing and a relatively sophisticated infrastructure. Therefore, alternative methods such as visual inspection after application of acetic acid (VIA), visual inspection with Lugol's Iodine (VILI) and human papillomavirus (HPV) DNA testing have been developed. The aim of present study was to compare Pap smear and VIA and evaluate their usefulness as tools for screening of premalignant and malignant lesions of cervix.

Methods: This was a crossectional study over 5 months from 1 Jan 2015 to 31 may 2015 in which 212 patients attending the obstetrics and gynecology department, BHU were enrolled. Pap smear was taken followed by VIA. Pap smears were sent to pathology department, BHU where they were reported as per Bethesda System, 2001. Cervical biopsies were done in positive cases. Data obtained and statistically analyzed.

Results: The present study was conducted over a period of 6 months among 212 patients age of 18-60 years screened. Positive results obtained from cytology were 26, VIA was positive in 28 women. Cervical biopsy was done in 34 women who had positive results by either test. Histology in 31 cases was suggestive of cervical intraepithelial carcinoma (CIN).

Conclusions: VIA, though less specific has comparable sensitivity to Pap smear and may be used as a primary screening tool for cervical cancer. In combination both the tests have a higher predictive accuracy.



Bhattacharyya AK, Nath JD, and Deka H Comparative study between Pap smear and visual inspection with acetic acid in screening of CIN and early cervical cancer J Midlife Health. 2015;6(2):53–8.

Bhatia N, Mukhopadhyay A, Kriplani A, Pandey RM, Gravitt PE, Shah KV, Iyer VK, Verma K. Evaluation of adjunctive tests for cervical cancer screening in low resource settings. Indian J Cancer. 2007;44:51-5.

Sale HS Can visual inspection with acetic acid is used as an alternative to Pap smear in screening cervical cancer? Middle East Fertility Society Journal. 2014;19(3):187–91.

Perkins RB, Langrish SM, Stern LJ, Figueroa J, Simon CJ. Comparison of visual inspection and Papanicolau (PAP) smears for cervical cancer screening in Honduras: should PAP smears be abandoned? Trop Med Int Health. 2007;12(9):1018-25.

Ghosh P, Gandhi G, Kochhar PK, Zutshi V, and Batra S. Visual inspection of cervix with Lugol's iodine for early detection of premalignant & malignant lesions of cervix Indian J Med Res. 2012;136(2):265–71.

Luthra UK, Prabhakar AK, Seth P, Agarwal SS, Murthy NS, Bhatnagar P, et al. Natural history of precancerous and early cancerous lesions of the uterine cervix. Acta Cytol. 1987;31:226–34.

Consul S, Agrawal A, Sharma H, Bansal A, Gutch M, Jain N. Comparative study of effectiveness of Pap smear versus visual inspection with acetic acid and visual inspection with Lugol's iodine for mass screening of premalignant and malignant lesion of cervix Indian J Med Paediatric Oncol. 2012;33(3):161–5.

Fahey MT, Irwig L, Macaskill P. Meta-analysis of Pap test accuracy. Am J Epidemiol. 1995;141:680–9.

Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytological abnormalities: a systematic review. Ann Intern Med. 2000;132:810–9.

Sankaranarayanan R, Thara S, Sharma A, Roy C, Shastri S, Mahe C, et al. Accuracy of conventional cytology: Results from a multicentre screening study in India. J Med Screen. 2004;11:77–84.

IARC handbooks of cancer prevention: Cervix cancer screening. Lyon, France: IARC Press;2005.

Mahmud G, Tasnim N, Iqbal S. Comparison of Visual Inspection with acetic acid and Pap smear in cervical cancer screening at a tertiary care hospital. J Pak Med Assoc. 2013;63(8):1013-6.

Satyanarayana L, Asthana S, Bhambani S, Sodhani P, Gupta S. A comparative study of cervical cancer screening methods in a rural community setting of North India. Indian J Cancer. 2014;51:124-8.

Ferris DG, Wright TC, Litaker MS, Richart RM, Lorincz AT, Sun XW, et al. Triage of women with ASCUS and LSIL on Pap smear reports management by repeat Pap smear, HPV DNA testing or colposcopy. J Fam Pract. 1998;46:125-34.




How to Cite

Singh, A., Singh, K., & Agarwal, N. R. (2017). Correlation of Pap smear and visual inspection with acetic acid for screening of premalignant and malignant lesion of cervix. International Journal of Research in Medical Sciences, 3(9), 2382–2385.



Original Research Articles